Our body is continually growing new hair. As new hair grows, the old hair is shed. It is usual for an individual to shed or lose between 50 to 100 hairs a day. Hair loss occurs when excessive shedding (beyond the typical 50-100 hairs a day) or when the hair follicles become dormant or destroyed, resulting in the lack of new hair growth. Hair loss can occur for numerous reasons and can be temporary or permanent. Some common types of hair loss include: alopecia areata, telogen effluvium, female pattern hair loss, male pattern hair loss, traction alopecia, central centrifugal cicatricial alopecia, and frontal fibrosing alopecia. Treatment options vary depending on the type of hair loss.

Alopecia areata is an autoimmune condition where the body’s own immune system targets and shuts off hair production in the hair follicles, leading to characteristic circular, coin shaped patches of hair loss. The hair loss can affect any hair bearing areas of the body including the scalp, eyebrows, eyelashes, and beard region. The degree and severity of the condition can vary greatly. In some, it is localized with few patches of round, circular, coin shaped areas of hair loss. In more significant cases, a person can lose all the hair on their scalp (alopecia totalis), and rarely, even the hair on their entire body (alopecia universalis). Alopecia areata can be associated with nail changes including pitting and ridges. The course of the disease can be unpredictable - hair can regrow spontaneously without treatment, and new areas of hair loss can appear out of the blue. Various therapies are available ranging from topical medications to intralesional steroid injections to systemic medications.

Central centrifugal cicatricial alopecia (CCCA) is a scarring alopecia - a condition which leads to destruction of the hair follicle and permanent hair loss. It predominantly affects middle aged Black women. Affected individuals experience a gradually expanding, circular area of hair loss that starts at the crown of the scalp and continues to radiate outwards, leaving behind shiny skin devoid of any hair follicles. Though genetics and hair care practices have been postulated to play a role in the development of the condition, the exact cause remains unknown. While there is no cure, various therapies have been tried. Treatment options include topical medications, intralesional steroid injections, and oral medications such as antibiotics and antimalarials. Discontinuation of any traumatic hair care practices is also highly encouraged.

Female pattern hair loss, known as androgenetic alopecia, is the counterpart of the more widely recognized male pattern hair loss. Unlike men with a receding hairline and hair loss on the top and front, female pattern hair loss presents with the widening of the part line, which can progress to generalized thinning. The condition is hereditary. In addition to genetics, hormones may also play a role. The onset is typically around or shortly after menopause, and the condition progresses slowly. While no cure exists, various treatment options are available to slow the progression, including topical therapies, oral medications, and/or hair transplantation. Low-level light therapy and platelet-rich plasma are additional treatment options that may be pursued.

Frontal fibrosing alopecia is a relatively new hair loss condition that was first described in the 1990s. Though initially thought of as a rare condition, frontal fibrosing alopecia has become increasingly more common with the reported incidence increasing worldwide. The cause remains unknown. Classically, it affects white, post-menopausal women over the age of 50. Affected individuals notice a band-like area of hair loss along the anterior hairline resulting in a receding frontal hairline. The skin in the affected area is pale, shiny, and devoid of any hair follicles. Occasionally, there can be single lone hairs that remain in the bald areas. It is not uncommon for affected individuals to also experience scarring hair loss of the eyebrows. While there is no cure, various therapies have been tried. Treatment options include topical medications, intralesional steroid injections, and various oral medications.

Male-patterned baldness or androgenetic alopecia is the most common form of hair loss affecting men. The condition can start as early as late teens or early twenties but typically is more common in older men. By 50 years of age, approximately 50% of white men will have some degree of male pattern hair loss. The classic presentation includes a receding hairline and hair loss on the top and front of the head. The causes are likely multifactorial including both genetics and hormones. The condition is slowly progressive. While no cure exists, various treatment options are available to slow the progression, including topical therapies, oral medications, and/or hair transplantation. Low-level light therapy and platelet rich plasma are additional treatment options that may be pursued.

Telogen effluvium is a common cause of temporary hair loss caused by excessive shedding of telogen or resting hairs. All hair cycles through the stages of hair growth - from growing to involution to resting and eventually shedding. In a normal scalp, about 90-95% of hair follicles are in the growing phase, with only about 5-10% of the hair being shed. In telogen effluvium, a stressful event triggers more hair to stop growing and enter the shedding phase, resulting in a disproportionate number of hairs being lost simultaneously. This generalized shed usually occurs about 3 months following the precipitating event. Common examples of situations that cause increased stress on the body include: childbirth, significant illness, surgical operation, extreme weight loss or dieting, certain medications, and even psychological stress (death of a loved one, divorce, etc). Telogen effluvium is a self limited process. Typically, the hair grows back within 3-6 months after the precipitating stressor has been eliminated.

Traction alopecia is a type of hair loss that occurs as a result of the hair being pulled too tightly. It commonly occurs in hair styles such as ponytails, buns, tight braids, cornrows, hair weaves, and hair extensions. The prolonged traction or pulling leads to hair breakage and resultant hair loss in the affected areas, commonly around the anterior hairline or in between tight braids. In its early stages, the hair loss can be reversible. However, long standing traction and pulling ultimately leads to permanent, irreversible hair loss. Treatment and prevention relies on changing hairstyle practices. Individuals should not wear their hair in styles that cause pain, instead opting for looser styles. If tight braids or weaves are preferred, wearing them for short periods of time and alternating with other loose hair styles can be helpful.